This ecologic study is an analysis of the HIV surveillance records from publicly funded HIV test sites in North Carolina from May 1991 through July 1996. We will be using the data to determine (a) the impact of HIV testing policies on test-seeking, (b) factors that are most predictive of test-seeking both overall and among African Americans specifically, and (c) the geographic distribution of test-seeking and how it has changed over time. In 1991, the availability of anonymous HIV tests were limited to 18 of the 100 counties in NC, as part of a plan to phaseout anonymous tests in the entire state. In 1993, anonymous testing became available again in all 100 counties. We propose to analyze data before, during, and after the restriction of anonymous testing to determine the impact the policy change had on test-seeking behavior in NC from 1991-1996. Since the HIV epidemic is disproportionate among African Americans as compared to their representation in the US, we will determine the statistical predictors of test-seeking among them and compare it to whites. Finally, we will examine the influence county characteristics, such as degree of urbanization and poverty level, have on test-seeking behavior. Census data from 1990 will be used to obtain county information. Spatial analysis will be used to examine geographic clustering of testing among the 100 counties in the state. These data provide a unique opportunity to examine policies that have recently been under controversy in North Carolina. Also, the spatial analysis may suggest the areas that need to be targeted, such as rural counties, when developing prevention and educational programs. Due to the growth of the AIDS epidemic among African Americans, these analyses will probably demonstrate the urgent need to ensure that they are seeking HIV tests.
